The electrocardiogram and the athlete.

Physiological adaptations of the heart to prolonged, intense physical training produce electrocardiographic changes considered abnormal in untrained persons. Increased vagal tone, anatomical changes in the heart, and other less understood mechanisms are thought to cause a spectrum of surface ECG changes characteristic of trained athletes. Arrhythmias frequently seen include sinus bradycardia, sinus pauses, and supraventricular ectopic beats. Conduction abnormalities such as prolonged P-R interval, first degree AV heart block, Wenckebach type I AV heart block, non-sinus escape rhythms, and intraventricular conduction delays of right bundle branch type are also found. Other commonly seen abnormalities include right axis deviation, increased right and left ventricular voltage, ST segment elevation, diphasic and inverted T waves, and prominent U waves. Changes in ECG parameters with exercise include a shortening of the P-R interval with a concomitant increase in the P wave/P-R interval ratio, improved AV conduction with cessation of Wenckebach phenomenon, and normalisation of ST segment and other T wave changes. Thallium scintigraphy and radionuclide angiography have been very useful in ruling out ischaemic heart disease in athletes with rest- and exercise-induced repolarisation abnormalities. Racial differences in QRS voltage and repolarisation changes have been documented. In summary, it is important to consider the type of physical activity, intensity of training, race of athlete, body habitus, and the time the ECG was obtained in relation to training in order to better understand the "normal' spectrum of ECG changes in athletes.